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Jyothi et al. | Journal of Clinical and Translational Research 2024; 10(1): 18-24 19
glycation end-products (AGE) and their receptors (RAGE) results d. Adults aged 18–65 years
in the transduction of various signaling pathways, leading to the e. Treatment-naïve patients
generation of ROS, pro-inflammatory cytokines, and chemokines Individuals with the following features were excluded from the
that would trigger cellular dysfunction [7]. study:
In the development of diabetic complications, unfavorable a. Pre-diabetic adults with HbA1c between 5.7% and 6.4%
hyperglycemia induces biochemical as well as hematological b. Individuals using oral hypoglycemic agents or insulin for the
changes. Due to altered biochemical and blood tissue products, management of diabetes
their interactions lead to alteration in erythrocyte functional c. Individuals using vitamin A or multivitamin supplemented
properties, leukocyte indices, and platelet indices in diabetes with vitamin A for any non-related conditions
mellitus [8]. A large cohort study in Israel found that a rise in d. Subjects addicted to smoking/alcohol/drug abuse
white blood cell (WBC) count serves as an independent risk e. Pregnant or lactating women
factor for T2DM development in normoglycemic subjects not f. Individuals with acute or chronic liver disease
being affected by other risk factors such as obesity, family history, g. Subjects who had received blood transfusions in the previous
or dyslipidemia [9]. Total count, differential number of WBC, 3 months
and neutrophil/lymphocyte ratio (NLR) are known markers of h. Individuals with symptomatic thyroid dysfunction
inflammation. High NLR is associated with insulin resistance i. Patients on lipid-lowering drugs
and acts as a prognostic marker in T2DM along with glycated j. Patients on hormone replacement therapy, including oral
hemoglobin (HbA1c) [10]. contraceptive drugs
Vitamin A, an antioxidant [8], can be obtained as provitamin A k. Patients with acute infections
carotenoids like β-carotene from edible plants or as retinyl esters l. Patients who were too ill to participate or had emergency
from animal sources [11]. The data regarding serum vitamin A health conditions
levels in T2DM patients are ambiguous. Despite the controversy m. Patients on antiepileptic drugs
surrounding the vitamin A status changes in T2DM patients,
new evidence lends credibility to decreased vitamin A levels in The demographic data and relevant history were obtained using
individuals suffering from T2DM [4,12]. a questionnaire. The biophysical profiles of subjects, encompassing
As there is a paucity of reports on the association of serum height, weight, waist circumference (WC), and hip circumference
retinol and hematological parameters with T2DM, the preliminary (HC) were recorded using standard techniques. Single-trained
study was designed to determine the association of the above personnel recorded weight using the same digital weighing scale
parameters in subjects with T2DM and healthy controls. The with a minimum graduation of 10 grams. The height of each
objectives of this study were to estimate the serum retinol, individual (standing straight with arms at the side and knees
hematological parameters, and indicators of glycemic control kept together) was measured using the same stadiometer with a
in T2DM and healthy controls; compare them between the two minimum graduation of 1 mm. The WC and HC were measured
groups; and investigate the correlation of fasting blood glucose using a measuring tape; the WC was measured at the narrowest
and HbA1c with serum retinol and hematological parameters in portion of the waist above the umbilicus when the individual was
the two groups. standing upright and the HC was measured at the broadest part of
2. Methods the hips. The body mass index (BMI) and waist–hip ratio (WHR)
were calculated.
The patients who attended our non-communicable disease Fasting venous blood was collected for all biochemical and
(NCD) prevention clinic in AIIMS, Bhubaneswar, India, from hematological investigations. HbA1c and fasting plasma glucose
August 2018 to August 2019, were recruited to this cross- (FPG) were estimated using Beckman Coulter AU 5800 fully
sectional, observational study after giving consent to participate. automated chemistry analyzer coupled with reagent kits from
Ethics approval was granted to this study (IEC approval number: Beckman Coulter (Ireland), after quality checks using QC material
IEC/AIIMS BBSR/PG Thesis/2018-19/10 dated – 13 July from Bio-Rad. Serum retinol was estimated by reverse-phase high-
th
2018). Convenient sampling was conducted to recruit cases pressure liquid chromatography (HPLC) in HPLC Agilent LC
and age-matched healthy controls. The procedures used in this Infinity 1200. Measurements of WBC count, red blood cell (RBC)
study adhered to the tenets of the Declaration of Helsinki. Study count, hemoglobin (Hb), hematocrit (HCT), mean corpuscular
participants were given clear explanations regarding this study volume (MCV), mean corpuscular hemoglobin (MCH), mean
in languages they understand, and informed written consent corpuscular hemoglobin concentration (MCHC), platelet
was obtained from each of them. Participants were coded with (PLT) count, red cell distribution width–coefficient of variation
numbers to ensure anonymity. (RDW-CV), platelet distribution width (PDW), mean platelet
The inclusion criteria of cases and controls are as follows: volume (MPV), platelet larger cell ratio (P-LCR), plateletcrit
a. Adults who consented to participate in the study (PCT), neutrophil, lymphocyte, monocyte, and eosinophil
b. T2DM adults with HbA1c levels ≥6.5% (as cases) parameters of complete hemogram were performed in fully
c. Non-diabetic adults with HbA1c <5.7% (as control) automated analyzer SYSMEX XN 1000 (Sysmex America, Inc.,
DOI: https://doi.org/10.36922/jctr.00194